Provider Demographics
NPI:1255451563
Name:ROBERT J S MACK, MD PC
Entity type:Organization
Organization Name:ROBERT J S MACK, MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-755-9393
Mailing Address - Street 1:1220 W HIGGINS RD
Mailing Address - Street 2:STE 102
Mailing Address - City:HOFFMAN EST
Mailing Address - State:IL
Mailing Address - Zip Code:60169-4033
Mailing Address - Country:US
Mailing Address - Phone:847-755-9393
Mailing Address - Fax:847-755-1560
Practice Address - Street 1:1220 W HIGGINS RD
Practice Address - Street 2:STE 102
Practice Address - City:HOFFMAN EST
Practice Address - State:IL
Practice Address - Zip Code:60169-4033
Practice Address - Country:US
Practice Address - Phone:847-755-9393
Practice Address - Fax:847-755-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6046380001OtherNATIONAL GOVERNMENT SERVICES
IL582060Medicare PIN
IL6046380001Medicare NSC